Changes in the outcomes of severe trauma patients from 15-year experience in a Western European trauma ICU of Emilia Romagna region (1996–2010). A population cross-sectional survey study

Saverio, Salomone Di; Gambale, Giorgio; Catena, Fausto; Giorgini, Eleonora; Ansaloni, Luca; Amadori, Niki; Coniglio, Carlo; Giugni, Aimone; Biscardi, Andrea; Magnone, Stefano; Filicori, Filippo; Cavallo, Piergiorgio; Villani, Silvia; Cinquantini, Francesco; Annicchiarico, M.; Gordini, Giovanni; Tugnoli, Gregorio

doi:10.1007/s00423-013-1143-9

Cited by 46 publications

(43 citation statements)

References 26 publications

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“…Several studies have reported that such injuries mostly occur at the age of 30 to 40 years with 60 to 80% in the male gender. [2,3,8] In our study, median age was 36.9 and male gender was 78.9%. The main causes of blunt trauma injuries are road traffic accidents, followed by falls from height.…”

Section: Discussionmentioning

confidence: 50%

“…The mortality rate has been reported to be lower in healthcare centers where trauma management is satisfactory. [3,6,7] FAST was first described by Rozycki and friends in 1996 and has an important role in the diagnoses of trauma patients in the ER. [9,10] FAST, which is rapid, easy to perform, cheap, and repeatable, can be performed in hemodynamically stable and unstable patients.…”

Section: Discussionmentioning

confidence: 99%

“…[1] Blunt trauma injuries, which often present with multi-trauma involving more than one anatomical structure of the body, are the main causes of emergency admissions. [2,3] Therefore, management and follow-up of these injuries require a multidisciplinary approach. The mortality and morbidity rate of blunt trauma injuries are higher than penetrating trauma injuries.…”

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confidence: 99%

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Multivariate analysis of patients with blunt trauma and possible factors affecting mortality

Özpek

Yücel

Atak

et al. 2015

Ulus Travma Acil Cerrahi Derg

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Section: Discussionmentioning

confidence: 50%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Multivariate analysis of patients with blunt trauma and possible factors affecting mortality

Özpek

Yücel

Atak

et al. 2015

Ulus Travma Acil Cerrahi Derg

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“…However, there is no agreement of opinions concerning trauma severity assessment criteria able to classify the injuries as polytrauma. When stratifying polytrauma patients, many authors rely on damage severity ranked on a scale of 16 and more with 17-25% risk of fatal outcome according to ISS (Injury Severity Score) [7,8]. Others [9] consider the presence of several injuries assigned 2 scores in no less than two anatomical regions according to AIS (Abbreviated Injury Scale) to be relevant for diagnosing polytrauma.…”

Section: Criteria For Polytrauma and Its Severitymentioning

confidence: 99%

Assessment of Severity and Prognosis of Polytrauma Outcome: the Current State of the Problem (Review)

Seliverstov¹,

Shapkin²

2017

Sovrem Tehnol Med

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The review deals with modern methods of assessing the severity and predicting the outcome of polytrauma. To solve the problem of objective evaluation of polytrauma severity, numerous studies are devoted to the search for independent predictors of its outcome, many of which are included in various scales and statistical models to quantitatively rank the severity of injury in the established intervals and calculate the survival probability. It is generally accepted to take into account the anatomical criteria to determine the severity of damage, and physiological parameters that characterize the response of the body functional systems to the damage. Age, sex, comorbidities, various clinical parameters, indices of acidosis, coagulopathy, oxidative stress, inflammatory response, timely diagnosing and the quality of treatment, the need of rendering various types of emergency aid are considered as independent risk factors of fatal polytrauma outcome.The predictive value and comparative effectiveness used in polytrauma scales assessing the severity of injuries (ISS, NISS, APS, ICISS, TMPM) and functional disorders (GCS, RTS, APACHE II, MODS II, SOFA, SAPS II, MPM II) as well as a variety of combined clinical and anatomical evaluation systems (TRISS, ASCOT, RISC II, PTS, etc.) are being actively discussed in the modern literature. Creating a universal scale is complicated by a variety of damages and disorders caused by a polytrauma, and insufficient study of injury outcome predictors. The proposed survival rates and prognostic factors are tied to specific polytrauma databases differing in terms of mortality and quality of medical care, which is reflected in their predictive value.A clear definition of polytrauma and formation of a unified system of assessing its severity would allow physicians to standardize treatment policy, objectively solve the problems of organization and financial support of medical help to seriously injured people.Key words: polytrauma; prognostic factors in polytrauma; mortality in polytrauma; scales and systems of injury severity evaluation.For contacts: Pavel A. Seliverstov,

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“…Worldwide, multiple traumas are a leading cause of death (1). While in the nineties of the last century traumatic brain injury accounted for 58.4% of causes of death, the distribution of causes of death has changed today, showing a reduction of traumatic brain injuryrelated mortality but an increase of deaths due to multiple organ failure (MOF) and sepsis (2). Of interest, MOF after multiple traumas developed to the main mechanism leading to sepsis and death despite the major progress of intensive care management achieved during the last two decades (3).…”

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confidence: 99%

Déjà-vu from the nineties: is there a perspective for anti-endotoxin strategies to improve the outcome of multiple trauma patients?

Histing

Menger

2016

J. Thorac. Dis.

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A recent cohort study of Charbonney et al. indicates that multiple trauma patients develop endotoxemia also in the absence of Gram-negative infection. This is most probably due to an increase of gut permeability. Non-survivors as well as patients with cardiovascular dysfunction and multiple organ failure (MOF) show significantly higher endotoxin levels at 24 h after injury compared to survivors and patients without MOF. These results are like a déjà-vu from the nineties of the last century, where several studies reported endotoxemia during the initial 24 h after multiple trauma with development of MOF and death at endotoxin levels >10 and >12 pg/mL, respectively. Of interest, other multiple trauma patient studies in the nineties have shown endogenous anti-endotoxin antibody production in survivors and reduced antibody production in non-survivors, which died from MOF. Although all these studies have pointed towards a mechanistic role of endotoxin in the fatal outcome after multiple injuries, clinical anti-endotoxin studies are still lacking. Thus, the future perspective must be prospective randomized multicenter trials, which have to elucidate the capability of anti-endotoxin treatment strategies to improve outcome in multiple trauma patients.

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Changes in the outcomes of severe trauma patients from 15-year experience in a Western European trauma ICU of Emilia Romagna region (1996–2010). A population cross-sectional survey study

Cited by 46 publications

References 26 publications

Multivariate analysis of patients with blunt trauma and possible factors affecting mortality

Multivariate analysis of patients with blunt trauma and possible factors affecting mortality

Assessment of Severity and Prognosis of Polytrauma Outcome: the Current State of the Problem (Review)

Déjà-vu from the nineties: is there a perspective for anti-endotoxin strategies to improve the outcome of multiple trauma patients?

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